Interview with Rubén Tovar: professional intrusion into online therapy

The field of psychotherapy can give rise to ambiguities when deciding which psychologist to go to. Therefore, labor intrusion in this area is a very present reality that must be taken into account.

How to detect cases of intrusion and choose fully trained professionals to practice psychological therapy? The psychologist Rubén Tovar gives us the keys to this.

Interview with Rubén Tovar: how to identify work intrusion in psychotherapy

• Related article: "The 8 benefits of going to psychological therapy"

Ruben Tovar Bordon He is a psychologist specialized in online therapy, and directs the terapiaencasa.es psychological assistance health center. In this interview he talks about the criteria to follow to choose a psychologist from the point of view of the person seeking professional help.

Do you think that the field of applied psychology is especially given to labor intrusion?

Yes, definitely. Already in the past, before online therapy spread, there was labor intrusion.

This intrusiveness comes from within and from outside the profession. I explain. In the past, I am talking about the last 10 years, above all, there were many psychologists who, without having the specific training or authorization to practice as mental health performed different types of therapies, even having 'pirate' centers without licenses, or any type of guarantees and some were not even collegiate This is a situation that I have been denouncing since 2009.

But more bloody was the case of different profiles of professionals who without having psychological or psychiatric training applied or carried out psychological therapies. Sometimes, these therapies were copied from the techniques or orientations most used in psychology. In other cases they were, directly, therapies of doubtful efficacy or, even, deceptive.

In addition, this intrusiveness is aggravated because clients rely a lot on the experience of what another person told them that it went well for them; without asking for formal references or seeing if the professional is accredited.

In Spain, if you are a psychologist and want to practice as such, you are required to be a PIR (Clinical Psychologist) and PGS (Health Psychologist). In addition, you must be registered, have civil liability insurance and have a registered health center.

On the other hand, there is a legal vacuum in the therapeutic field that is taken advantage of by other professionals, who use the word 'therapy' and even use terms like 'psychology', which are not required absolutely nothing.

And from what you have been seeing... are there people without training in psychology who advertise as online psychotherapists, taking advantage of the fact that they do not need to invest in a store?

Currently, in the online part it is becoming an increasingly serious problem. Sometimes, many do not have adequate training, or have training but are not authorized to practice (because you can have training but NOT be able to practice as a psychotherapist).

On other occasions, we find many websites that advertise quality psychology services, etc., and the profiles of the professionals who provide the therapies do not even appear. That is, we do not know if he is a psychologist, psychiatrist, educator or social worker.

On many occasions we have received patients who had used these services, which were advertised such as 'online psychologists' or 'online psychology center', even promising 'brief and effective’. By digging a little, we see that it is almost impossible to access the professional profile of therapists, at most they say they have a 'degree in psychology'. And that they are not very transparent if clients ask them for credentials.

At this point, I do not want to be misunderstood: I am totally in favor of multidisciplinary interventions and I believe that very good interventions can be carried out legally. Intrusiveness is nourished, more and more, by the lack of knowledge and lack of protection that the patient has, who often accepts something for good that he does not know if it is either.

The websites that advertise with this type of services should clearly expose the professional profile of their psychologists, or failing that, the training of their professionals, and indicate that they are health centers authorized. In addition, even if they do not perform physical intervention, all their professionals must have their collegiate number visible and be registered in their civil liability insurance. Everything else, apart from the fact that it is an informality, in reality what it hides is a blatant intrusion.

Surely many people believe that psychotherapy is basically a chat, something similar to a dialogue you might have with a friend. Do you think that the fact that we usually associate video calls with a more informal context than a face-to-face meeting with the psychologist is one of the factors that favors intrusion?

I think they are different things, but I do think that intrusiveness favors that negative opinion that therapy is just chatting.

In psychological therapy you don't just talk. Therapy is and should be a regulated and programmed scientific process, where the difficulties, the context and all areas of the patient are evaluated. A type of intervention is always established following the guidelines or models that are currently validated. In addition, the sessions carry a prior preparation, therapeutic objectives are sought, personal goals are established with the patient, etc.

For this reason, the problem of intrusiveness is not only a matter of poor orientation or use of theoretical aspects of doubtful efficacy, but also of professionals who really lack basic or specialized training and base their intervention on that, simply chat and let the patient vent. For this reason, the context of video calls or whether a physical center is more formal or informal is a matter that depends entirely on the professionals.

I have been in centers that, without judging if they are better or worse, have a more or less careful aesthetic, or a more or less informal presentation; I have even been to psychology centers that are more similar to a general practitioner's office.

Everyone, whatever their presentation or appearance, seems fine to me; because these aspects are really just a vision of how you want to carry out the therapeutic process, but while is carried out by professionals who comply with professional ethics and legality, it should not be perceived as a problem.

In the case of online therapy, the same thing happens. Video calls normally, especially in my case and that of my colleagues in terapiaencasa.es, we establish some protocols of what the environment from which we care for our patients should be, as well as the interaction with these. In our case, we want to give an image of what we are: a serious, safe and professional service.

We must never forget that, even if we are on a video call, we are still a health center.

From the patients' point of view, what are the main implications of this intrusion?

The intrusiveness leads to bad diagnosis, to carry out ineffective therapies and to give a bad image of the profession.

In the best of cases, the patient will only suffer a little frustration, but it is very likely that he will not try again. In the worst case, it will precipitate a critically ill patient to become destabilized and he may harm himself or those around him; or even that certain problems that could have been solved by a qualified professional become chronic.

What advice would you give to someone looking for online therapy services but who has no experience selecting professionals?

I really like this question. The first thing is do not get carried away by beautiful words: free, years of experience, maximum quality, etc. You have to look at specific data.

Does the website have any reference to a professional association or does it indicate a health center number? If you don't have it, ask for it by email, if you don't get suspicious.

Does the collegiate number of your professionals appear? It is something mandatory to give psychological therapy.

Is the training visible or transparent, where did they study or what masters or postgraduate degrees they have?

Are they clinical or health psychologists, psychiatrists, educators, coaches with formal training??? because even if one does not look for a psychologist, other professionals must give us guarantees. Look for the professional in the corresponding college.

Does the center follow data protection regulations? It may seem silly, but no one would want their data to appear anywhere along with their treatment report.

Finally, always look for real external references that indicate if they really are good professionals. Opinions on the internet are not enough, because there are many cheeky people who make them up.

For example, do you have any published books, have they appeared in any public media, do you work in other centers or entities, do you have positive references in serious portals, etc?

And with regard to the regulation of the profession, what aspects do you think are necessary, taking into account that online therapy is becoming more and more popular?

It seems essential to me that professional associations dedicate themselves to actively pursuing all these intrusive frauds, which the only thing that will generate is that in the long run our profession will be underrated. I also think that other entities could do better.

Certain platforms do ask for the collegiate number (which is great because in others they totally ignore it).

But, there are also many who, knowing the environment and knowing the obligations, do not ask the professionals who advertise no accreditation regarding their qualification to practice as clinical/health psychologists.

Finally, there are some magazines and outreach portals that advertise professionals without checking if they really claim to be what they are. It does not cost anything to request a collegiate number or a title that enables you.